Laserfiche WebLink
O�Z ' <br /> Burnett County 7410 Co. Rd. K, No. 702, Siren,WI 54872 Office of Zoning Administrator 01 o <br /> APPLICATION FOR LAND USE PERMITS d 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 g <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. m <br /> OWNERI"Qtl� E ,teJtO� YLhh — II,J/I1LI/YI%(� QLEPHONE jIrV51--7 � ZB --- <br /> m I <br /> HOME ADDRESS A q q-I I 614 m L.k ILLI <br /> `I p <br /> EMERGENCYIFIRE NUMBER d� ROADNAME��l Clam it dl, <br /> 51 a-a5 ✓ 334 P '2/3 <br /> LEGAL DESCRIPTION (see tax receipt) /HCl l# 9&Ilo ba008900 PC[$ /2 <br /> CONTRACTOR <br /> M <br /> o' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION o r- <br /> m O <br /> O �• <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT qq SUBD�IV.ISION o <br /> G ��DQti1 1./�NS(fucliUn/ _ <br /> STRUCTURE/ADDITION USE: O ' Dec-KCSO —7 h / t4l7 n 5� h.-1)7r- <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> o m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 N <br /> 'r Z i <br /> 1. All required dimensions or distances to be shown or drawn to scale. m P <br /> o <br /> 2. Show the location and size of all existing buildings(EB) and all new buildings (NB)and indicate o <br /> North (N). m 1 <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m 9_� <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, <br /> roads, lake, lot lines. I <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be r <br /> signed and dated by the owner. v <br /> iQ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. N SU <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. u; <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Uj <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY p <br /> PERMITTED. _ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> (nco N-0 r- > <br /> S > O m <br /> g.Q '' > j cn. F <br /> m 7. o.� - o.m ' _ y <br /> `z N O <br /> Z <br /> - <br /> CA 1 <br /> 8. P d : <br /> F <br /> ULf " e, /LU <br /> O <br /> (, . <br /> o M <br /> I declare that this application (inclu ng any accompanying schedule) has been examined by me and to the best of my w E m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Oum N O <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize Y 5: P o <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am v <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ix <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. ,n <br /> m <br /> m <br /> SIGN HER <br /> (sl sture of owner or building co (date) <br /> ZONING ADMINISTRATOR p <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 000 ' o m <br /> OOoo o y <br /> c0 <br />